PhysioAI: Clinical Knowledge-Guided Semantic Supervision for Skeleton-Based Physiotherapy Action Recognition

Skeleton-based action recognition can support automated tracking of physiotherapy exercises, particularly in remote rehabilitation settings where continuous in-person supervision is impractical. However, most existing methods are developed for large-scale daily-action benchmarks rather than rehabilitation scenarios. Public rehabilitation exercise datasets are typically small, with only subtle kinematic differences between exercise classes. For participants with motor impairments, exercise execution may also deviate from standard movement patterns in amplitude, speed, and coordination, increasing intra-class variability and making reliable recognition more difficult for skeleton-based models. We propose PhysioAI, a clinical knowledge-guided semantic supervision framework that injects structured physiotherapy knowledge into skeleton representation learning. PhysioAI combines graph-based spatiotemporal modelling of human movement with training-time semantic anchors derived from a structured Clinical Knowledge Dictionary (CKD). The CKD descriptions are encoded using a frozen Contrastive Language-Image Pre-training (CLIP) model and projected into an anchor space, where they provide class-specific semantic targets for skeleton representation learning. The resulting CKD-derived anchors are used only during skeleton-model training; inference requires only skeleton inputs. Under subject-disjoint evaluation, PhysioAI achieves 99.03±1.34% on KiMoRe Overall, 94.64±7.36% on the Hard-67 stress test, and 87.44±7.69% on UI-PRMD Overall. These results exceed the strongest comparator for each endpoint by 0.27, 2.87, and 1.33 percentage points (pp), respectively. These findings demonstrate that structured clinical knowledge can serve as an effective source of training-time supervision for physiotherapy action recognition.